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Swellengrebel, H.A.M.; Peters, E.G.; Cats, A.; Visser, O.; Blaauwgeers, H.G.T.; Verwaal, V.J.; ... ; Marijnen, C.A.M. (2011)

Multidisciplinary Discussion and Management of Rectal Cancer: A Population-based Study

Article / Letter to editor
The purpose of the present study was to evaluate the value of discussing rectal cancer patients in a multidisciplinary team (MDT). All treated rectal cancer patients (> T1M0) diagnosed in 2006-2008 were included. According to the national guidelines, neoadjuvant (chemo)radiotherapy should be given to all rectal cancer patients. Patients were scored as "discussed" (MDT+) only if documented proof was available. The primary endpoint was the number of positive circumferential resection margins (CRM a parts per thousand currency sign1 mm). Of the 275 patients included, 210 were analyzed (exclusions: (recto)sigmoid tumor, acute laparotomy, and inoperability). Neoadjuvant treatment was applied in 174 (83%) patients and followed by total mesorectal excision in 171 (81%) patients. Patients considered not to require downstaging, received short-course radiotherapy (SCRT) (n = 116) or no radiotherapy (no RT) (n = 36), whereas 58 more advanced patients received chemoradiotherapy (CRT). The MDT...Show moreThe purpose of the present study was to evaluate the value of discussing rectal cancer patients in a multidisciplinary team (MDT). All treated rectal cancer patients (> T1M0) diagnosed in 2006-2008 were included. According to the national guidelines, neoadjuvant (chemo)radiotherapy should be given to all rectal cancer patients. Patients were scored as "discussed" (MDT+) only if documented proof was available. The primary endpoint was the number of positive circumferential resection margins (CRM a parts per thousand currency sign1 mm). Of the 275 patients included, 210 were analyzed (exclusions: (recto)sigmoid tumor, acute laparotomy, and inoperability). Neoadjuvant treatment was applied in 174 (83%) patients and followed by total mesorectal excision in 171 (81%) patients. Patients considered not to require downstaging, received short-course radiotherapy (SCRT) (n = 116) or no radiotherapy (no RT) (n = 36), whereas 58 more advanced patients received chemoradiotherapy (CRT). The MDT discussion took place in 116 cases (55%). In the MDT+ group an MRI was used more often (p = 0.001) and TNM staging was more complete (p < 0.001). The proportion of patients with advanced disease was higher in the MDT+ group (88% a parts per thousand yenT3/N+ versus 68%; p = 0.001). The overall CRM+ rate was 13% and did not differ between the MDT+ and the MDT- group (p = 0.392). In patients receiving SCRT or no RT, the CRM+ rate was 10%, whereas the rate was 20% for patients receiving CRT. Although no difference in CRM+ rate was found for those patients who were discussed and those who were not, our results demonstrate room for improvement, especially in the selection of patients for SCRT or no RT. We advocate standardized documentation of treatment decisions and pathology reports.Show less
total mesorectal excision preoperative radiotherapy postoperative chemoradiotherapy resection margin randomized-trial local recurrence phase-iii mrc cr07 surgery multicenter
All authors
Swellengrebel, H.A.M.; Peters, E.G.; Cats, A.; Visser, O.; Blaauwgeers, H.G.T.; Verwaal, V.J.; Velthuysen, M.L. van; Cense, H.A.; Bruin, S.C.; Marijnen, C.A.M.
Date
2011-09-30
Journal
World Journal of Surgery
Volume
35
Issue
9
Pages
2125 - 2133
DOI
doi:10.1007/s00268-011-1181-9